Health and Sport Committee

Meeting date: Wednesday, February 23, 2011

Official Report 471KB pdf

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Subordinate Legislation

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Public Services Reform (Social Services Inspections) (Scotland) Regulations 2011 (Draft)

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Public Services Reform (Joint Inspections) (Scotland) Regulations 2011 (Draft)

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Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011 (Draft)

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Healthcare Improvement Scotland (Inspections) Regulations 2011 (Draft)

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Public Services Reform (Scotland) Act 2010 (Consequential Modifications) Order 2011 (Draft)

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Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (Draft)

Item 2 is an oral evidence-taking session with the Minister for Public Health and Sport and Government officials on six affirmative instruments, all of which relate to the upcoming establishment of healthcare improvement Scotland and social care and social work improvement Scotland.

Members will recall that we considered parts 4 and 5 of the Public Services Reform (Scotland) Bill in the autumn of 2009, which dealt with the establishment of those two new organisations. At that time, we reported our conclusions and recommendations on the bill to the Finance Committee, which was the lead committee on the bill.

We have a cover note setting out the instruments and the Subordinate Legislation Committee’s comments. We also have a letter from the minister setting out the purpose of each instrument.

Once the evidence session is over, we will consider motions to approve four of the six instruments. The motions to approve the remaining two instruments will be considered as soon as the Subordinate Legislation Committee has formally commented on them. The Subordinate Legislation Committee considered the two instruments yesterday, so we should have its comments in time for our next meeting on 2 March.

I draw to members’ attention the seven negative instruments that we will consider under agenda item 7, which also deal with HIS and SCSWIS. If members have any questions on those instruments, it would be useful to put them to the minister while we have her here, so that we can consider the subject matter of all the instruments together.

I welcome the witnesses from the Scottish Government: Shona Robison MSP, Minister for Public Health and Sport; Anne Aitken, head of health quality branch, quality division; Adam Rennie, deputy director of community care; and Kirsty McGrath, solicitor in the food, health and community care division. I invite the minister to make brief opening remarks.

Thank you for the opportunity to speak in support of the instruments. Adam Ingram and I wrote to the committee last week setting out the background to and purpose of the instruments, which I hope was helpful to the committee.

Today, I intend to give a very brief introduction to the instruments. I will be happy to answer any questions. The instruments are required to complete the legislation in respect of the creation of the two new scrutiny bodies SCSWIS and HIS, which are being established as part of the Scottish Government’s drive for greater efficiency in public services, in particular in the bodies that scrutinise health and social services.

The instruments put in place a framework that enables the new bodies to regulate social care, social work and independent health care services by registering, where appropriate, and inspecting those services. Care services will be inspected against the current standards—the national care standards—which will ensure continuity for both providers and service users.

One issue that my letter did not mention is that we have now laid for the Parliament’s consideration a transitional and saving order, which will ensure that services that currently are registered will continue to be registered under the new legislation. Any condition notices, improvement notices and so on that are still in force at the end of March 2011 will also be carried forward.

Under the new inspection regime, ministers will approve the overall inspection plans for each body and any future changes that are proposed to those plans. The inspection regulations do not provide for a minimum frequency of inspections. That change will enable SCSWIS and HIS to develop proportionate and risk-based inspection regimes to ensure that scrutiny is focused on the areas of greatest risk.

I am happy to answer any questions that members have on the instruments.

Thank you very much. Richard, do you have a question?

Yes.

I am going to try to get other people in first this time, so if you do not want Helen Eadie and Mary Scanlon always to get in first—there is no harm in that—get your hand up fast.

I did not put my hand up for that reason. I am very happy to follow my colleagues.

I was fishing over at the other side of the table. Richard, you can start.

I have two questions for the minister and her team. One is about the Scottish health council. I am trying to remember what we finally decided in the Public Services Reform (Scotland) Act 2010. If I remember correctly, the council is to be subsidiary to HIS. You have announced that you are appointing a chair for the council, but we said that HIS had to reconstitute it. It was going to be abolished, but it has been retained. Will you clarify the situation?

The Scottish health council will continue and will have its own chair. The appointment process for the appointments that I have just approved, which will be made public shortly, included the identification of a chair for the council. The membership of the board will include a chair.

Are there only interim chief executives for the other bodies?

Yes. I can go into the reasons for that. However, to cut a long story short, following an open competition, the appointment panel did not recommend anyone for appointment by ministers as a substantive chief executive of SCSWIS. We were concerned about the delay that readvertising and so on would involve, therefore interim chief executives have been appointed for both bodies until the end of December. The good side of the arrangement is that the new boards will each be able to appoint their own person beyond that date. The two interim chief executives are people who know the score and will be able to offer continuity. At the end of December, the boards will each be able to appoint their own person going forward.

That is a helpful answer.

When we were debating these issues, we heard that care homes think that they are overinspected. I welcome your opening remarks about the reduced frequency of inspection, which will now be proportionate to the perceived quality of care homes, so that they do not have to be reinspected if they are meeting high quality standards.

However, we also heard the complaint that local authorities, which commission much care in care homes, also carry out a form of inspection; certainly, care homes are required to fill in extensive duplicated paperwork. As we move forward, what steps has the Government taken to try to eliminate that wasteful, time-consuming bureaucracy? I understand that local authorities say that they have a duty to ensure that the terms of the contracts for which they are contracting and commissioning are fulfilled. However, as part of the proportionate approach that I welcome from the Government, we must drive inefficiencies and duplication out of the system. I invite you to comment on that point.

I will ask Adam Rennie to say a little more about it. You are right—local authorities say that they are required to carry out their own inspections to ensure contract compliance. However, I agree with you that we need to reduce that burden, for lack of a better word. The costs to local authorities of their contract compliance systems are an issue for them. I think that we can find a more efficient, effective way of proceeding that can preserve the legal requirements for contract compliance and monitoring but which does not require significant investment by local authorities or place a burden on the providers who must meet those requirements.

I have little to add to what the minister has said, except to recall that, during the passage of what is now the Public Services Reform (Scotland) Act 2010, a provision was added that required local authorities, in effect, to acquaint themselves with the reports that the regulators have made on the services that local authorities are considering commissioning. That is a further linkage between the formal inspection system and local authorities’ commissioning system.

Much play has been made of the joint nature of such work. We decided not to go for a single unit at the moment but to have things really work together. You have added in two further bodies to the arrangement, which I welcome, but I wonder whether we should not go further in that respect. Instead of saying merely that local authorities should have regard to reports, we might say that, when some form of inspection is being carried out, local authorities should be informed of that and, perhaps, second an individual to be there, so that the processes are completed at exactly the same time and the paperwork is dovetailed.

We will have to look at all those things as we drive further efficiency in the system. Certainly, local authorities will want to consider more effective ways in which to carry out what they are required to do. I am sure that we can have dialogue on that.

The letter from the minister and Adam Ingram is helpful, but the language concerns me. The second paragraph states:

“The 2010 Act ... places a duty on ... local authorities and health boards when providing care ... services ... to consider reports and other information”.

On the second page, it continues:

“SCSWIS and HIS will analyse evidence and other information ... From this analysis they will report on the quality of services, how risks can be minimised and problems addressed.”

I appreciate Richard Simpson’s points about reducing inspections, but I am concerned about increasing self-evaluation. I am on record as saying—I make no apology for it—that the existing regulation, monitoring and inspection of care homes and nurseries by the Scottish Commission for the Regulation of Care is not good enough; it makes recommendations and does not follow them up. Many people save all their lives and can pay up to £1,000 a week in a care home and we have the most expensive nursery education in Europe. What reassurance can the minister give people who cannot work because they cannot afford child care or who do not work because they are concerned about putting their children into child care because of the standards?

We appear to be moving towards a softer-touch approach with fewer inspections and more self-evaluation. How can you reassure people whose parents are in a care home or parents whose children are at a vulnerable age and are in nursery education that we are moving to something that is better than the current arrangements, which I do not consider to be good enough?

I dispute strongly that the new arrangements will be a softer touch. The whole purpose and thrust of the new regime is that it should be more proportionate and risk based. Therefore, the poorly performing care homes and nurseries to which the member refers can expect more attention under the new regime, because it will be an intelligence-based system. The purpose of self-evaluation is to ensure that good providers that constantly receive good reports, are valued by clients, are well thought of and that score highly maintain that quality and are covered by a proportionate inspection regime, so that far more time can be spent on services that do not come up to scratch. Standards can be driven up by spending more time with providers in which the quality is not as good as it should be. In fact, the new system will begin to address far more effectively some of the issues that the member raises.

The argument is probably for another day, but I will certainly take what you say at face value. I have found from personal experience and from constituents that many recommendations from three, four or five inspections have been ignored and the care commission has done nothing. I hope that you are right, but I will certainly continue my individual scrutiny. I am almost more concerned about nurseries than about care homes, given what I have seen and been told.

I hope that I can reassure you on that. One point is that there is a direct correlation between the system of grading care homes and the resource that they receive. In effect, investment, good management and good service in a care home are rewarded directly through the grading it gets and consequently the resource it receives.

There have been improvements, but is everything perfect? No, it is not, but I believe strongly that this system will allow the inspectors to do what they want to do, which is to spend far more time with the services that need to have time spent on them.

11:00

I have a final point, convener. I was recently talking to a young mum who was shocked that the nursery that her son was in had the lowest possible rating. We have to be better at communicating with those who are paying for such services to let them know about the ratings, because parents and other individuals will drive up standards. Parents will not want to put their children into the worst-rated nursery—often at the highest price—but that is an issue for another day.

That was not really a question, was it?

No, but my point is that there is no point in giving ratings if people do not know what the ratings are.

Communication is important. The whole point of having a grading system is to ensure that there is consumer choice and that the information is produced in a simple form so that people do not have to read through all the reports, which is obviously difficult for many people to do. The grading system is a way of making the information visible. There are sometimes nuances—within the higher gradings, the difference between a couple of gradings can be down to something on the day of the inspection—but the process certainly sorts out the ones that are at the top of the grading system from those in which big improvements require to be made.

I want to be clear about how the reforms will impact on the current care service architecture. The issue that comes to mind is how the new regime will apply to what are often specialist joint health and social work teams—the team is largely health-based but a number of social work professionals work within it. Such teams operate in, for example, mental health.

How will the regime apply to the inspection and regulation of such teams? Which of the two bodies that are responsible for such teams—the health service and the local authority—will be responsible for considering and therefore responding to any findings from a report?

I will pass the question on to Adam Rennie, but I will first try to answer it as broadly as I can.

It may be appropriate to have a joint inspection by the two bodies if there is a large component of both health and social care. I am trying to think of such a service but I cannot off the top of my head. Perhaps a joint inspection may be appropriate in the circumstances that you describe.

If issues arise that impact on both health and social care, I would have thought that it would be for both bodies to ensure follow-up and compliance with any requirements that are made. Does Adam Rennie want to add anything?

Yes. Thank you, minister.

I would see a distinction between the individual service-level provision that might be being commissioned as a result of such joint working, when the inspection regime would depend on the particular service that was being commissioned—in most cases SCSWIS would be the scrutiny body—and the higher level areas to which the minister referred when two statutory agencies, the health board and the local authority, are working together. In the latter case, joint inspection arrangements may be appropriate—or it may be appropriate to have, at a less formal level, a multi-agency inspection in which the various agencies work together on an inspection. That does not have the status of a joint inspection, but it involves the bodies coming together in their own right to carry out the work.

Who would have to consider the findings would depend to some extent on what the findings were but, by and large, one would expect that they would need to be addressed jointly, if it was a joint exercise.

There are teams in some health board areas in Scotland that are largely health-led but have a social work component, and the standards that apply to the team are set by the health board. When it comes to inspection of that type of team under the current regime, how can a local authority be held to account for a health board standard that might not be being met but is found in the inspection report?

That is a good question and we might need to consider it further. I suppose that that situation could be captured in some kind of operational guidance about what should be done when the integration of the team is such that it would be hard to not apply the health requirements. It might be a bit silly if they were not applied to the whole team. We need to look at having some sort of operational guidance for such circumstances. We have not given any particular thought to that. Perhaps we should consider what we are asking the two bodies to do. We would not want to fragment an integrated team when it came to any action points for follow-up, for example. We need to think about that.

I agree with the minister. The integrated team from the two statutory bodies working together would mean a different form of scrutiny or regulation from the individual service, which might well be what was emerging from the workings of the team—

No. I am entirely with you, but what you are saying is going in the wrong direction. I am talking about a health-led joint team that has embedded local authority staff and which is managed by the health service, but the local authority staff’s contracts and management line technically go through social work. I am not talking about service provision but about the standards that should be applied to that team. If the health standards are applied to the social work staff, who have a direct line of management to health board members in the team, but whose professional responsibilities are to social work, which standards are to be applied? Who is held to account for those standards being met? Who is responsible for conflict resolution? The local authority might not agree with the standards that the health service might want to impose on the team. There could also be personnel issues for the local authority.

Such issues might already exist to some degree in integrated teams. Where do they sit and what standards apply, given that their line management accountability is different from where they sit in employment terms?

The move towards more integrated teams probably means that we will have to consider that issue in more depth. While we move towards a more fully integrated system across the board, an interim solution might be one that takes the operational nature of the team into account—what is important for the outcomes for service users in that situation and what applies to the team. We do not want to not apply something that is important to the outcomes for service users and which could improve the service because some of the team is technically employed by the council, albeit that they are managed by an NHS manager.

The interim solution that we will have to consider will involve an examination of what it makes sense to do in operational terms in order to drive up standards to deliver better outcomes for service users, if standards are found to be lacking. It is a good point, and certainly one that we will take away. We might write to the committee once we have had a think about what we could put in place to capture some of that.

Does the point that Michael Matheson has raised also apply to those arrangements that would cover the regulation covering community health partnerships and community health and care partnerships, which would result in exactly the same position as Michael Matheson was positing, whereby a local authority person would collaborate with health employees under regulations governing CHPs and CHCPs that are driven by the national health service regulations?

The CHCPs operate under the governance arrangements of the health board. They have no legal status of their own at the moment. In some ways, the same issue may apply—

It would be helpful if you brought the issue into the round.

The issue is to do with separating the governance and management arrangements with regard to who leads the team from the requirements in terms of professional standards, for example. Further, who someone is legally employed by might be a different matter from the operational nature of their day-to-day job as part of an integrated team under an NHS manager. We have not explored that very far, but we want to take it away.

A number of issues have been raised in the on-going consultation on the self-directed support bill so that we can gather the public’s views on the integration of health and local authority services, and on how standards in health can be applied to local authorities and vice versa.

I accept that that is a matter of fact, but it does not answer either Michael Matheson’s question or mine. If what I have just posited comes within the ambit of all of that, it would be helpful if the minister were able to bring all of that together.

We can find some kind of interim solution that captures that scenario while discussions go on elsewhere about the integrated nature of the future of those services.

I see you indicating, Rhoda. Do not fret; you are on my list. I am alive and I am looking at you.

We could have a debate about that.

We will not have a debate about whether I am alive or not.

You are looking well, convener.

Is the issue not to do with the standards rather than the body that is reviewing them? In the Highlands and Islands, care homes and small community hospitals share services such as laundry and catering and the situation can become difficult for them, because care homes and hospitals have different standards of service. That is almost a barrier to integrating services, even though, in small communities, it is much easier to have those services based together.

It should not be beyond the wit of man to say that, within a hospital, because people are quite vulnerable, we need a certain standard of heat, food and laundry and that, therefore—if the services are integrated—the standards in the care home must be the same. However, I think that some of the regulations that are in place around water temperature and so on in care homes prevent that. It might be that someone needs to sit down and come up with a sensible approach to shared services that can cope with both circumstances.

It might be possible for work to be done on coming up with common standards. I hope that the requirement for HIS and SCSWIS to work together and look at such issues will result in some simplifications of the situation and, perhaps, the adoption of a shared approach that might involve a common set of standards in the scenario that you are talking about. We can certainly flag that up with the new bodies as being something that we would like them to have an early look at.

11:15

That concludes our evidence-taking session. Item 3 on the agenda is a debate on the motions to approve the instruments before us. As no member wishes to speak in the debate, we will move straight to the questions.

Motions moved,

That the Health and Sport Committee recommends that the Public Services Reform (Social Services Inspections) (Scotland) Regulations 2011 be approved.

That the Health and Sport Committee recommends that the Public Services Reform (Joint Inspections) (Scotland) Regulations 2011 be approved.

That the Parliament recommends that the Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011 be approved.

That the Health and Sport Committee recommends that the Healthcare Improvement Scotland (Inspections) Regulations 2011 be approved.

Motions agreed to.

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Social Care and Social Work Improvement Scotland (Requirements for Reports) Regulations 2011 (SSI 2011/26)

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Social Care and Social Work Improvement Scotland (Fees) Order 2011 (SSI 2011/27)

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Social Care and Social Work Improvement Scotland (Registration) Regulations 2011 (SSI 2011/28)

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Social Care and Social Work Improvement Scotland (Applications) Order 2011 (SSI 2011/29)

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Healthcare Improvement Scotland (Fees) Regulations 2011 (SSI 2011/33)

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Healthcare Improvement Scotland (Requirements for Reports) Regulations 2011 (SSI 2011/34)

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Healthcare Improvement Scotland (Applications and Registration) Regulations 2011 (SSI 2011/35)

The next agenda item concerns the consideration of seven negative instruments associated with the establishment of healthcare improvement Scotland and social care and social work improvement Scotland. Members have a copy of each of the instruments and a note from the clerk.

Do members have any comments?

Members: No.

Are members content not to make any recommendation to the Parliament on the instruments?

Members indicated agreement.

I thank the minister and her officials for their attendance.

11:17 Meeting continued in private until 12:01.